Perioperative GLP-1 Receptor Agonist Use is Associated With Reduced Revisions and Complications Following ACDF: A Propensity-Matched Analysis

Study DesignRetrospective cohort study.ObjectivesGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are prescribed for obesity and type 2 diabetes mellitus (T2DM) and exhibit anti-inflammatory and osteogenic effects which may influence fusion outcomes. This study evaluated the association between preoperative GLP-1RA use and perioperative complications, resource utilization, and revision rates after anterior cervical discectomy and fusion (ACDF) in patients with T2DM.MethodsThe TriNetX Global Network was queried for patients with T2DM undergoing single-level or multi-level ACDF. GLP-1RA users were defined by prescriptions within 6 months before and after surgery. Propensity score matching controlled for demographics, comorbidities, and socioeconomic factors. Outcomes included medical and surgical complications, revision rates, and healthcare utilization at 90 days, 6 months, and 1 year.Results608 single-level and 639 multi-level GLP-1RA users were compared with matched nonusers. GLP-1RA use was associated with lower revision rates after single-level ACDF at 90 days (OR:0.445, <i>P</i> = 0.032) and 6 months (OR:0.489, <i>P</i> = 0.034). Pseudarthrosis risk was reduced across all timepoints for both single-level and multi-level ACDF (OR:0.296-0.608, all <i>P</i> ≤ 0.008). GLP-1RA users also had lower dysphagia risk following single-level ACDF across all timepoints (OR:0.506-0.661, all <i>P</i> ≤ 0.030). Resource utilization was decreased, with fewer readmissions (single-level: OR:0.401-0.634; multi-level: OR:0.418-0.593, all <i>P</i> ≤ 0.003) and ED visits (single-level: OR:0.563-0.697, all <i>P</i> ≤ 0.007) across all timepoints. On multivariate Cox regression, GLP-1RA use independently predicted reduced pseudarthrosis at 1 year (HR:0.665, 95% CI:0.570-0.775, <i>P</i> = 0.005).ConclusionPerioperative GLP-1RA therapy was associated with reduced rates of pseudarthrosis, revision, dysphagia, and healthcare utilization following ACDF without increased adverse events.